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Health plan budget impact analysis for pimecrolimus.

Jane Chang1, Jennifer Sung

  • 1Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, USA. jane.chang@pharma.novartis.com

Journal of Managed Care Pharmacy : JMCP
|January 26, 2005
PubMed
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The introduction of pimecrolimus cream 1% for atopic dermatitis (AD) showed a minimal increase in per-member-per-month (PMPM) costs. This study found that pimecrolimus had a negligible impact on overall healthcare spending for eczema treatment.

Area of Science:

  • Pharmacoeconomics
  • Dermatology
  • Health Economics

Background:

  • Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition affecting a significant portion of the population.
  • Managed care organizations require robust budget impact models to inform drug formulary decisions.
  • Pimecrolimus cream 1% is a topical calcineurin inhibitor used for AD treatment.

Purpose of the Study:

  • To estimate the incremental budgetary impact of introducing pimecrolimus cream 1% for atopic dermatitis.
  • To analyze changes in per-member-per-month (PMPM) medical and pharmacy costs associated with AD treatment.
  • To evaluate the cost-effectiveness of pimecrolimus within a managed care setting.

Main Methods:

  • Utilized 2001-2002 US health plan claims data for approximately 2.5 million members.

Related Experiment Videos

  • Assessed patient care-seeking behaviors, treatment patterns, and medication dispensing for AD.
  • Applied 2003 wholesale acquisition costs for medications and Medicare reimbursement rates for physician visits.
  • Incorporated clinical trial efficacy data to model pimecrolimus's impact on subsequent healthcare utilization.
  • Conducted sensitivity analyses to test the robustness of the findings.

    • Main Results:

    • In 2001, 3.2% of health plan members sought care for AD, with a total treatment cost of $0.362 PMPM.
    • Following pimecrolimus introduction, 5.2% of the AD population filled a prescription.
    • The incremental pharmacy cost was $0.008 PMPM, while the total incremental medical and pharmacy cost was $0.002 PMPM (a 0.7% increase).
    • Sensitivity analyses indicated a range of incremental total costs from -$0.004 to $0.026 PMPM.

    Conclusions:

    • The addition of pimecrolimus cream 1% had a minimal impact on PMPM costs for AD-related care.
    • Pharmacoeconomic models suggest that health plans should conduct their own budget forecasting using proprietary data.
    • The findings support the integration of pimecrolimus into AD treatment protocols with minimal budget implications.